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NPI Code Detail

MEDICARE: DR. BRUCE RICHARD WOLFFIS OD

MEDICARE: DR. BRUCE RICHARD WOLFFIS OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristBW002561MI

General Provider Information

NPI Number : 1104865252
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE RICHARD WOLFFIS OD
Provider Business Mailing Address
First Line : 35184 CENTRAL CITY PKWY
Second Line :
City : WESTLAND
State : MI
Zip : 48185-6215
Country : US
Telephone Number : 734-427-5200
Fax Number : 734-427-8136
Provider Business Practice Location Address
First Line : 735 JOHN R RD STE 150
Second Line :
City : TROY
State : MI
Zip : 48083-5859
Country : US
Telephone Number : 248-577-3659
Fax Number : 248-588-9917
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 10/28/2020

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